Trochanteric plate for bone surgery



Sept. 30, 1952 J.IG. COLLISON 2,612,159

TROCHANTERIC PLATE FOR BONE SURGERY Filed March 1, 1949 ntot I Qtto cgPatented Sept. 30, 1952 craoonanrnaro PLATE Fen eons SURGERY John G.oouisen, Greensboro, N. o.; Marie B.

Collison administr'atrix of said John G. Collison, deceased ApplicationMarch 1, 1949, Serial N0. 79,026

The invention relates to improvements in trochanteric plates for use inbone surgery, and one of the objects of the invention is to provide sucha plate that will produce greatly improved results in the treatment ofhip fractures, such as neck fractures or trochanter fractures, wherenails or screws are used, and in femoral head prosthesis operations.

Another object of the invention is to provide a trochanteric plate soconstructed that it will maintain the shaft which carries the artificialhead, in femoral head prosthesis operations, perfectly rigid and in theexact position in which it was originally inserted, and likewise, in pinoperations, in fractures of the neck or the trochancar, will maintainthe nail or screw used perfectly rigid and in fixed position laterally,thereby preventing any overriding of the femur on the head, andpermitting union of the fractured parts.

A further object of the invention is to provide a trochanteric platewhich, in pin operations, using either nail or screw, the nail or screwand plate are freely movable, relatively, longitudinally of the nail orscrew, in the event of absorption.

Another object of the invention is to provide a trochanterio plateadapted to use either in femoral head prosthesis operations or in pinoperations, with either nail or screw, in cases involving fracture ofthe trochanter or the neck of the femur. I

Various other objects and advantages of the invention will be apparentto those skilled in the art of bone surgery, from the following detailed11 Claims. (01. 128-92) description, taken in connection with theaccompanying drawings, in which:

Figure 1 is an elevational view, with parts in section, of thetrochanteric plate with surgical nail mounted in place on the femur;

Figure 2 is a similar view of the troohanteric plate with a surgicalscrew;

Figure 3 is a similar view but showing the trochanteric plate incombination with the parts used in a femoral head prosthesis operation;and

Figure 4 is a perspective view of the trochanteric plate.

Referring to the drawings in more detail, numeral I indicates the upperportion of a femur, including the femoral head 2, the femoral neck 3,and the greater trochanter 4. In Figures 1 and 2 a fracture of thefemoral neck is indicated by a line 5. It should be mentioned here thatthe bone structure is illustrated merely diagrammatically, and noattempt has been made to give an anatomically correct illustrationthereof, either interiorly or exteriorly, as that is obviously entirelyunnecessary.

The preferred structure of the troohanteric plate will first bedescribed, and then willfollow a description of its application in hipoperations.

Referring particularly to Figure ernumeral 6 indicates the trochantericplate generally. This plate has a shank portion 1 which is preferablycurved in cross-section to conform generally to the shape of the bone,and is provided with the desired number of holes 8, four in theembodiment illustrated, to receive screws 9, for perma nently securingthe plate in position. The screw holes are preferably countersunk, asshown.

Carried by the shank portion '3 is a tubular portion or member ID. Theshank. portion and the tubular portion are preferably formed integral,as shown, but it will be apparent that the two parts may be formedseparately and then be rigidly united by any desired means.

This tubular portion I0 is of substantial length and extends at an angleto the shank portion which is approximately the angle between the shaftand neck of the femur. In other words, the angle between the shaft andthe neck of the femur differs somewhat in different persons, as much as10 degrees, and the tubular portion of the trochanteric plate isarranged at an angle to the shank thereof which is the mean or averageangle in femurs, about 135 degrees, so that the plate is applicable toall femurs.

Adjacent its outer end, the tubular member it may be provided interiorlywith an annular shoulder II.

The trochanteric plate as a whole constitutes a strong and rigid device,which is preferably made of stainless steel, as are all other parts usedin connection therewith, though the invention is not limited to the useof any particular material. When the plate is secured in position on thefemur the tubular member extends a considerable distance into the boneand provides an exceedingly strong reenforcement for nails, screws,shafts, or other devices which may be used in cooperation therewith, aswill appear more clearly in the description of the application of theplate.

The tubular member is shown as round and cylindrical, exteriorly andinteriorly, and that is preferably the shape thereof, but of course itcould be oval, rectangular, triangular, etc., in cross-section, eitheron the outside or the inside;

it being necessary only that it be of such a shape as to receive andsupport or reenforce nails, screws, shafts, etc., used in hipoperations. Accordingly, the use of such words as tubular portion,section, or member, herein or in the claims, is not intended to defineor limit the element to any specific shape either on the inside or theoutside.

The use of the plate in connection with nails or screws, in thetreatment of fractures, will now be described, reference being had toFigures 1 and 2.

Merely as an illustration, a femoral neckfracture is shown. Beforeapplying the plate, a hole or cavity is formed in the neck of the femurof substantially the length and the cross-sectional size and shape ofthe tubular portion IU of the trochanteric plate. This hole or cavityextends toward the femoral head and of course is formed at the sameangle that the tubular member l bears to the plate shank 7. In boringthe hole, at exactly the same angle as that of the tubular member adrill jig is temporarily attached to the shaft of the femur, but adescription thereof is unnecessary as it forms no part of the presentinvention.

Thetubular member is. now. inserted in the openingand the plate is.permanently secured to the-femur shaft, as by. means of the screws 9.

These screws may extend through .theproximal and distal cortex, asshown, or. only through the proximal cortex.

With thetrochantericv plate now secured in place, an appropriate nail,such. as a flanged surgical nail I2, Figure l, is inserted in thetubular section [0 of the trochanteric plate, and

. then itis driven in, as by a mallet, until the nail nail is properlypositioned. And when the nail is in position the tubular. member, whichextends a considerable distance into the bone, provides an exceedinglystrong reenforcement for the nail,

and will rigidly maintain the nail laterally fixed l in exactly theposition in which it is inserted, and thereby hold the proximal anddistal fragments in proper alignment and prevent overriding of the femuron the head, and thus permit union ofthe fractured parts.

It will also be noted by reference to Figure 1 that the nail and thetubular section of the plate are freely movable, relatively,longitudinally of the nail, which is obviously of very considerableimportance in the event absorption occurs, for it permits the femoralshaft carryingthe tubular member ID to move upwardly along thenail tobring the fractured parts closer together while at the same timemaintainingthem aligned.

In Figure 2 a surgical screw [3 is shown in place of the surgical naill2. When surgical screws are used instead of nails, in pinningoperations, the tubular member of the plate functions in the same manneras above described in connection with the use of surgical nails. Thatis, the tubular. member will properly guide the screw into position, andby reason of its reenforcing function it will maintain the screw rigidlyin laterally fixed position and prevent any overriding of the femur onthe head, and as also previously described in connection with the use ofsurgical nails, the tubular member and the screw are freely movablerelatively, longitudinally of the screw.

Figure 3 illustrates the parts in a femoral head prosthesis operation.In this operation the acetabulum is cleared of. the. femoral head and anartifical head is substituted. The operation becomes necessary oradvisable where, from the result of a fracture or otherwise the headabsorbs,

or in some cases the operation may be performed at the time of thefracture. The operation also becomes necessary or advisable as theresult of ankylosis caused by certain types of arthritis. The presentinvention produces highly desirable results in those operationsrequiring the use of an artificial femoral head.

Numeral [4 refers to an artifical femoral head. In shape it ispreferably a segment of a sphere, and may be made of stainless steel orof other desirable material. Numeral l5 refers to a stainless steelshaft or rod. The central portion of thisshaftis of substantially thesame diameter as the-external: diameter of the tubular member ID.The'inner end of the shaft has a slightly reduced portion [6 forming ashoulder IT. The

' artificial'head I 4 is centrally bored so that the head will fitneatly on the reduced portion it, with the plane surface of thespherical segment abutting the shoulder H. The outer end of the shaftalso has a reduced portion, indicated by numeral i8,'to form a shoulderI9. This reduced portion inakesa neat fit in the tubular member [0, withthe shoulder 19 abutting the inner end of the tubular member. It will beunderstood, of course, that the natural, upward pull of the muscles willhold the artificial head and shoulder H. in abutting relation, and willalso hold in abutting relation the shoulder 19 and the end of thetubular member I 0.

' In applying the parts in this femoral head prosthesis operation, thefemoral head is first removed from acetabulum. Then the previouslymentioned drill jig is. temporarily attached to the shaft of the femuranda hole is bored all the way through the femoral neck. Then thetrochanteric plate is permanently attached to the femoral shaft in themanner hereinbefore described, with the tubular portion H] of the plateextending into the hole in the bone. Then the reduced portion i8 of theshaft is inserted in the tubular portion ll] of the trochanteric plate,with the shoulder 19 resting on the end of the tubular member, and theartificial head I4 is then placed on the reduced portion I-B oftheshaft, resting against the shoulder I1. The parts are now in positionready to reduce the ball into the acetabulum.

It will be apparent that in femoral head prosthesis operations thetrochanteric plate of the present invention performs a highly desirable"function, in that the.tubular member ID extending a considerabledistance into the bone and embracing the shaft which carries theartificial head, maintains the shaft in a rigid and laterally fixedvposition, which may well mean the difference between success and failurein this operation. It. will also be noted that while as previouslydescribed in pinning operations relative movement is permitted betweenthe tubular member. and the nail or screw, 1ongitudinally of thenail orscrew, no such relative longitudinal movement is permitted between thetubular member and the shaft in the femoral head prosthesis operation,for the artificial head abutsthe shoulder l1, and the shoulder I9 abutsthe. .end of. the .tubuar member.

. .Thereshould be no rotary movement of the shaft inthe tubular memberID, and the friction created. by the .sidewise pressure of the shaft inthe-tubular member prevents such rotary movement. However, insome casesit may be desirable to clamp these parts together, and accordingly thereduced end portion of the shaft may terminate short of the outer end ofthe tubular member, and the end of the shaft may be centrally threadedto receive a screw 20, the head of which screw'rests upon a washer 2|.Thus by turning the screw the shoulder IQ of the shaft will be firmlyclamped against the end of the tubular member ID.

From the foregoing description it will be apparent that the trochantericplate disclosed herein provides a marked advance in hip operations,particularly in pinning operations and in femoral head prosthesisoperations.

Having fully described the invention, what I claim is: I

1. In bone surgery, a trochanteric plate, said trochanteric platecomprising a shank portion and a surgical implement supporting portion,

said portions being rigidly connected, said shank portion adapted to besecured to the shaft of the femur, said implement supporting portionhaving substantial length and adapted to extend into the bone, and saidimplement supporting portion having a passage therethrough to receive abone surgery implement.

2. In bone surgery, a trochanteric plate, said trochanteric platecomprising a shank portion and a surgical implement supporting portion,said portions being rigidly connected, said shank portion adapted to besecured to the shaft of the femur, said implement supporting portionhaving substantial length and arranged at an obtuse angle to the shankportion and adapted to extend into the bone and said implementsupporting portion having a passage therethrough to receive abone-surgery implement.

3. In bone surgery, a trochanteric plate, said trochanteric platecomprising a shank portion and a tubular portion, said portions beingrigidly connected, said shank portion adapted to be secured to the bone,said tubular portion having substantial length and adapted to extendinto the bone, and the hollow of said tubular portion receiving a bonesurgery implement.

4. In bone surgery, a trochanteric plate, said trochanteric platecomprising a shank portion and a tubuar portion, said portions beingrigidly connected, the two portions permanently arranged atapproximately the angle that the neck of the femur bears to the shaft ofthe femur, and the tubular portion having substantial length and thehollow of the tubular portion receiving and reenforcing a bone surgeryimplement.

5. In bone surgery, a trochanteric plate, said trochanteric platecomprising a rigid shank portion and a rigidly connected tubularportion, said portions permanently, arranged at approximately the anglebetween the neck and shaft of the femur, and said tubular portion havingsubstantial length and the hollow of the tubular portion receiving andreenforcing a surgical nail.

6. In bone surgery, a trochanteric plate, said trochanteric platecomprising a rigid shank portion and a rigidly connected tubularportion, said portions permanently arranged at approximately the anglebetween the neck and shaft of the femur, and said tubular portion havingsubstantial length and the hollow of the tubular portion receiving andreenforcing a surgical screw.

'7. In bone surgery, a trochanteric plate, said trochanteric platecomprising a rigid shank portion and a rigidly connected tubularportion, said portions permanently arranged at substantially the anglebetween the neck and shaft of the femur, and said tubular portion havingsubstantial length and the hollow of the tubular portion in the hollowof said tubular portion and extending into the head of the femur, saidnail and tubular portion being freely movable, relatively,

longitudinally of the nail.

9. In bone surgery, a trochantericplate, said trochanteric platecomprising a rigid shankportion and .a rigidly connected tubularportion, said shank portion adapted to be secured to the femur shaft,said tubular portion having substantial length and arranged at anangleto the shank portion approximating the angle between the neck andshaft of the femur and extending into the bone, a surgical screw mountedwith a neat fit inthe hollow of said tubular portion and extending intothe head of the femur, said screw and tubular portion being freelymovable, relatively, longitudinally of the screw.

10. In bone surgery, a trochanteric plate, said trochanteric platecomprising a rigid shank portion and a rigidly connected tubularportion, said shank portion adapted to be secured to the femur shaft,said tubular portion arranged at an angle to the shank portionapproximating the angle between the neck and shaft of the femur andextending into the bone, a shaft mounted in said tubular portion andextending through the neck of the femur, and an artificial femur headmount ed on the inner end of said shaft. v 1 1'. A fracture nail supportdevice comprising a tubular portion adapted to enter the head of a femurand a plate portion adapted to extend along the femur shaft adjacent thehead, said portions being rigidly interconnected and the plate portionextending laterally from one end of the tubular portion such that theaxis of the tubular portion forms an obtuse angle with the plane of theplate portion, said tubular portion having an inner diameter adapted toaccommoe date a' fracture nail.

1 JOHN G. COLLISON.

REFERENCES CITED The following references are of record in the file ofthispatent:

UNITED STATES PATENTS Number Name Date 2,243,717 Moreira May 27, 19412,397,545, Hardinge Apr. 2, 1946 2,441,765 Hopkins May 18, 19482,500,370 McKibben Mar. 14, 1950 OTHER REFERENCES Piedmont HospitalBulletin for 1937, page 24.

La Presse Medicale for May 3, 1947, page 302 copies of both publicationsin Div. 55.

Journal of Bone and Joint Surgery-1941, page 807.

The Journal of Bone and Joint Surgery for July 1950, advertising page34'; (Copy of the above publication in Div. 55.)

